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Mitral Valve Procedures Without Aortic Cross Clamping via Right Minithoracotomy Using Titanium Fasteners
Rafik Margaryan, Giacomo Bianchi, Tommaso Gasbarri, Giovanni Concistrč, Pierandrea Farneti, Marco Solinas.
Ospedale Del Cuore Fondazione 'G. Monasterio', Massa, Italy.

OBJECTIVE: We sought to review our experience with use of new titanium knot fastener devices. We hypothesised that in selected cases its use could reduce the induced ventricular fibrillation (IVF) or beating heart procedure time, cardio-pulmonary bypass (CPB) time importantly.
METHODS: We reviewed retrospectively our electronic records in order identify the patients who underwent mitral valve (MV) repair and replacement without aortic cross-clamping (on beating heart or induced ventricular fibrillation, mainly redo operations). Surgical approach was trough right minithoracotomy with mainly femoro-femoral arterio-venous cannulation. A part of patients have used fast knotting system (FK group, Cor-Knot Device, ISL Solutions Inc) and remaining served as control group (conventional hand knotting, HK). We identified the FK patients and performed propensity score matching to match 1:1 ratio from main population using FK versus HK.
RESULTS: A total of 55 underwent mitral valve repair or replacement on fibrillating or beating heart without aortic cross-clamping. A total of 13 (24%) patients underwent operation using FK. There were no statistical difference in total population while ignoring the procedure type and complexity on mitral valve. However, when subsetting procedures on native valve, there were around 35 minutes reduction of CPB time (p = 0.06). Same pattern was persisted when considering only IVF and there were time reduction by 9 minutes (p = 0.38). In propensity matched population the effect of CPB and IVF reduction was consistent and repeated by 18 (p = 0.45) and 15.5 (p = 0.29) minutes reduction, respectively.
CONCLUSIONS: Titanium fasteners are useful tool to have in minimally invasive approaches, especially in complex cases and redo interventions. Titanium fasteners can reduce IVF time and overall CPB time in selected complex population. In matched group the pattern of reduction of two variables were consistent.


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